Boil it down

[Guest eureka]

There is truth in laying some blame at the federal Liberals door for the decay of the system in Canada. There is none in not sharing it with the presures of Regionalism and the sins of the Provinces in misapplying funding and in playing political games by refusing to have national standards rigidly spplied.

The Liberals were simply engulfed with the "Right Wing" mania that swept the world from about 1980: by the new orthodoxy that was no more than a reversion to 19th. century ideas. The Market; Globalization; Balanced Budgets: Defict rediction; and other slogans that became a substitute for policy and governance.

What is needed is to jettison the baggage that came with those aberrations and to get back to the progressive social and economic policies that were so successfuly transforming the world in the few decades previous.

It is not just our healthcare that has suffered from this. The whole world has been diminished. Economic growth has slowed in every advanced nation and has actually been reversed in most poorer nations. Social condition has been set back to the levels of the 1950s.

Now, in the context of this discussion, the "Right" would entrench the losses for the people and the gains for the few onto law.

[kimmy]

While I realize you couldn't let pass an opportunity to beat your "The regionalists, children! The regionalists!" drum, I don't think it's particularly relevant to the question of public vs private services.

Don't you think there's some merit to the view that the real blow to "social progress" in this country wasn't anything Mulroney or Manning did, but rather Paul Martin's 1995 budget? I'm sure I'll hear that the demagogues forced them to do it. "The demogogues, children! The demogogues!" who never once formed the government.

Your arguments just serve to try to deflect criticism from the people who have been running the country for the past 12 years. In any event, largely beside the point of what the Curious Sweal and I have been discussing.

-k

[The Terrible Sweal]

In our country we tend to place a high value on peoples' personal freedoms. Our constitution reflects this.  If people wish to engage in commerce with each other, they have the right to do so, ...  the onus should be on opponents of private care to demonstrate this compelling reason for restricting my ability to engage in commerce.

In a court case this is captured by the government having to demonstrate that Charter S.1 is met. I accede that this onus exists and is proper. Note that the SCC did not overule the Quebec law based on the Charter, so outside Quebec, the legitimacy of similar legislation is an open question.

Of course the managers have been the problem, or at least part of the problem.  Who, if not the Saviors of Healthcare Party , do you propose will bring about the utopia you envision? 

It's hardly utopian. For the purposes of this discussion, I don't care who implements it.

I believe you've said you support the Liberals only because you don't like the alternatives... well, in your view, if the Liberals are the best we've got and they've brought the healthcare system where it is over the past 12 years, what hope do you have that your vision is ever going to become reality?

My vision was the reality until a few years of mismanagement led to the current "crisis".

But fundamentally, there's just the logic of it. I don't understand why people seem to think that preventing capital from being invested in the system, and restricting the number of places where medical professionals can work will somehow make the system stronger.

But that is not my position. I want that capital to come onstream too, I just say it can and should be pooled for the common good rather than for private benefit.

I'm asking you and others to give me a lucid reason why private is better than public. It is no answer to answer me that private is better than nothing.

Are you sure it's worked well for a number of years, or is it just that our standards were not very high for a long time? I honestly don't know the answer to that.

It worked well for a number of years.

Well, of course if anything goes wrong in Sweal-World it'd be an anomaly that could be fixed "forthwith".  But what about a real healthcare system? Like, say, the one we're stuck with?

The very point of our discussion is what each of thinks should be done. As such we are eac presuming we are not 'stuck with' the present conditions.

[Guest eureka]

I think you need to reread what I wrote. The Martin Budget of 1995 was a reflection of the Right Wing agenda that had swept much of the world. It was an observance of the Manning and Mulroney philosophies - if Mulroney actually had any beliefs.

It was also very much, in relatiom to healthcare, a Provincial problem. The federal government had only tenuous control of healthcare under an act that gave it no teeth for enforcement. Also, the federal government gave the provinces what they thought they had asked for in block transfers instead of dedicated funds. Some provinces reduced their healthcare funding and diverted monies to other needs.

The federal government also gave the provinces twi tax points that were not, in some cases and possibly all, not used for healthcare but transferred into general revenues.

Regionalism and Right Wing ideology played a very large part. Martin, himself, is a right winger and so is Chretien. They are just not bent as far as the Mannings and Mulroneys; the Thatchers and the Reagans.

[cybercoma]

Come on, CC, surely you can do better than a kneejerk ad hominem rant.  Or, maybe not.

<{POST_SNAPBACK}>

Wednesday night....I think that was more of a drunken rant. Whoops.

[Argus]

I think you need to reread what I wrote. The Martin Budget of 1995 was a reflection of the Right Wing agenda that had swept much of the world.

You mean the understanding (still a baffling mystery to most of the left) that you can only run big deficits for so long before you go bankrupt?

It was also very much, in relatiom to healthcare, a Provincial problem. The federal government had only tenuous control of healthcare under an act that gave it no teeth for enforcement. Also, the federal government gave the provinces what they thought they had asked for in block transfers instead of dedicated funds. Some provinces reduced their healthcare funding and diverted monies to other needs.

Nice. I love this. It was all the provinces fault. Not so much as a hint of recognition that slashing transfer payments to the provinces was ultimately responsible for major cuts in health care funding. No, it was just those evil provinces. No doubt they were all right wing "neo-cons" who hated the poor anyway, and of course, wanted to destroy public health care. Oh if only the noble Liberal Party of Canada could have protected us! But oh woe is us! It had only tenuous control!

And besides, they were kind of busy stealing us blind.

[Guest eureka]

I think you also need to reread. Take your time since, admittedly, the idea that the Right is wrong may be difficult for you.

[kimmy]

In our country we tend to place a high value on peoples' personal freedoms. Our constitution reflects this.  If people wish to engage in commerce with each other, they have the right to do so, ...  the onus should be on opponents of private care to demonstrate this compelling reason for restricting my ability to engage in commerce.

In a court case this is captured by the government having to demonstrate that Charter S.1 is met. I accede that this onus exists and is proper. Note that the SCC did not overule the Quebec law based on the Charter, so outside Quebec, the legitimacy of similar legislation is an open question.

Yes, I'm aware that the the decision applies only to Quebec. However, I'm sure that there will be challenges from elsewhere (I certainly hope Quebecers are not the only Canadians who have a guaranteed right to life and personal security!) And having ruled this way once, has the SC not established a precident?

Anyway, now that you've acceded that this onus exists and is proper, is the aforementioned compelling argument against private healthcare now forthcoming?

I think this is rather important. It appears (to me at least) that according to law, it's not up to proponents of private care to show that it would be *good*, its up to opponents of private care to show that it would be *bad* for the public interest.

But fundamentally, there's just the logic of it. I don't understand why people seem to think that preventing capital from being invested in the system, and restricting the number of places where medical professionals can work will somehow make the system stronger.

But that is not my position. I want that capital to come onstream too, I just say it can and should be pooled for the common good rather than for private benefit.

I'm asking you and others to give me a lucid reason why private is better than public. It is no answer to answer me that private is better than nothing.

But as I keep mentioning, I don't feel it's up to me to show you why I think private is *better* than public, I feel it's up to you to show me why private is *harmful* to the public good. You don't really have any reason to restrict my ability to engage in commerce unless you can show this.

But yes, I do think "private" offers some good things that public doesn't. As I explained in another thread I do think it would increase the capital investment in the system and help retain and attract health professionals to Canadian healthcare.

Here is another one: basic math. Your argument has been that if the capital exists, it should be taxed and put into the public system. Well, let's examine that.

Say I win $20 million in the lottery. Marginal tax rate is, what, 50% or something like that? I have no idea... but just say. So, I've got $10 million. And whatever I spend it on, I'm paying 7% GST. So, basically, the government has $10.7 million, and I have $9.3 million left of that $20 million. So, what do I do with my share?

Well, suppose I'm in Kim-World and I want to buy an MRI machine and operate a private clinic. Ok, so I sink the whole $9.3 million into healthcare infrastructure. Canada's health system is $9.3 million stronger.

But wait: what if I'm in Sweal-World? In Sweal-World, the marginal income tax on $20 million isn't 50%, it's maybe 60% and maybe GST is higher, too; maybe 8%, to provide stronger funding for healthcare. Of the initial $20 million, the government takes $12 million, and of the $8 million I have left, I pay another $640,000 in GST.

I spend my $7.36 million on ... I dunno, I buy an extravagant home and car and crap like that, and sink the rest into investment funds.

In Sweal-World, the government has taken $12.64 million of the lottery winnings, instead of $10.7 million. About 2 million more to spend, and maybe most of it even goes into the healthcare system (if the elected officials in Sweal-World are more honest and competent than the ones in Real-World, at least.)

So in Sweal-world, the result of stronger taxes on Kimmy's lottery winnings is that the healthcare system is $1.94 million stronger than it would be in Real-World. But in Kim-World, the healthcare system is $9.3 million stronger.

I think you'd agree that the demand for healthcare services is far higher than the supply of healthcare services. Isn't that supposed to be the kind of situation that inspires investment in a free-market economy? And yet we have laws to maintain a monopoly supply of this precious commodity... to whose benefit? I'm sorry, I just don't understand the logic.

Of course the managers have been the problem, or at least part of the problem.  Who, if not the Saviors of Healthcare Party ™, do you propose will bring about the utopia you envision? 

It's hardly utopian. For the purposes of this discussion, I don't care who implements it.

...

Well, of course if anything goes wrong in Sweal-World it'd be an anomaly that could be fixed "forthwith".  But what about a real healthcare system? Like, say, the one we're stuck with?

The very point of our discussion is what each of thinks should be done. As such we are eac presuming we are not 'stuck with' the present conditions.

The question of who is going to impliment it has bearing on the question of whether your poll is a reflection of any *real* choice facing Canadians. I maintain that it isn't.

-k

[August1991]

Reading through this thread, I get the impression Sweal wants society to guarantee a "basic minimum" to all citizens and Sweal includes health care in the basic minimum. IOW, Sweal wants a "guaranteed annual income". I suggest Sweal look at the "negative income tax" idea first.

Say I win $20 million in the lottery. Marginal tax rate is, what, 50% or something like that? I have no idea... but just say. So, I've got $10 million. And whatever I spend it on, I'm paying 7% GST. So, basically, the government has $10.7 million, and I have $9.3 million left of that $20 million. So, what do I do with my share?

Well, suppose I'm in Kim-World and I want to buy an MRI machine and operate a private clinic. Ok, so I sink the whole $9.3 million into healthcare infrastructure. Canada's health system is $9.3 million stronger.

But wait: what if I'm in Sweal-World? In Sweal-World, the marginal income tax on $20 million isn't 50%, it's maybe 60% and maybe GST is higher, too; maybe 8%, to provide stronger funding for healthcare. Of the initial $20 million, the government takes $12 million, and of the $8 million I have left, I pay another $640,000 in GST. I spend my $7.36 million on ... I dunno, I buy an extravagant home and car and crap like that, and sink the rest into investment funds.

Kimmy, I really admire your way of dealing with this zero-sum thinking. (Given your $20 million lottery prize, fixed-sum might be a better term.) Unfortunately, you make it seem like government wastes the tax money, or causes you to spend your winnings otherwise. And let's be real, do lottery winners buy MRIs? Kimmy, you sound anti-government. In fact, there's $30 million on the table: your lottery winning and the gain when the money is spent according to your desire. If you prefer, the $10 million is the extra effort of people who do waht you want.

IOW and IMV, the issue is more fundamental. English Canada, Ontario in particular, desperate for identification, has been lead down several mistaken paths - deliberately so by certain leaders. One of the mistaken paths is "everyone in Canada goes to the same hospital". On the face of it, this particular path (or idea) is absurd, impossible and, as I would say, Soviet.

I suspect the idea's attraction in part is that it distinguishes English Canada from America.

I will state this baldly. In the long run, no society can offer health services to all without imposing specific costs on some.

I think you need to reread what I wrote. The Martin Budget of 1995 was a reflection of the Right Wing agenda that had swept much of the world. It was an observance of the Manning and Mulroney philosophies - if Mulroney actually had any beliefs.

It was also very much, in relatiom to healthcare, a Provincial problem. The federal government had only tenuous control of healthcare under an act that gave it no teeth for enforcement. Also, the federal government gave the provinces what they thought they had asked for in block transfers instead of dedicated funds. Some provinces reduced their healthcare funding and diverted monies to other needs.

eureka, you don't get it. You think our health care system is in trouble because it lacks money (Mulroney, Martin, Harris never funded it properly). eureka, you're wrong. You are like an old Soviet who believes the Soviet system collapsed because of a lack of discipline.

Come on, CC, surely you can do better than a kneejerk ad hominem rant.  Or, maybe not.

<{POST_SNAPBACK}>

Wednesday night....I think that was more of a drunken rant. Whoops.

<{POST_SNAPBACK}>

*Giggle*

[The Terrible Sweal]

Yes, I'm aware that the the decision applies only to Quebec.  However, I'm sure that there will be challenges from elsewhere (I certainly hope Quebecers are not the only Canadians who have a guaranteed right to life and personal security!) 

Please don't play silly just for the mere sake of it. Of course others have such rights; what concerns us here is the meaning and extent of them.

And having ruled this way once, has the SC not established a precident?

Precedent applies only to what the court actually and specifically decides, not to what it does not decide. So no binding precedent applies to the Canadian charter from this case.

... is the aforementioned compelling argument against private healthcare now forthcoming?

It's already out there, and probably well enough known to you that I don't need to recite it here.

But as I keep mentioning, I don't feel it's up to me to show you why I think private is *better* than public, I feel it's up to you to show me why private is *harmful* to the public good. 

In thestructure of court case perhaps, but this is apulic policy debate. Anyway, private is less good than public because it is more expensive, not equitable and undermines the public effort.

...  I do think "private" offers some good things that public doesn't. As I explained in another thread I do think it would increase the capital investment in the system and help retain and attract health professionals to Canadian healthcare.

I have read these theads assiduously and I did not see any such explanation, though I hae seen many assertions to that effect. Please EXPLAIN why private investment will yield better outcomes than equivalent public investment.

... Your argument has been that if the capital exists, it should be taxed and put into the public system.  Well, let's examine that. ... I win $20 million in the lottery. Marginal tax rate is, what, 50% or something like that? I have no idea... but just say. So, I've got $10 million. And whatever I spend it on, I'm paying 7% GST.  So, basically, the government has $10.7 million, and I have $9.3 million left of that $20 million. So, what do I do with my share?

Well, suppose I'm in Kim-World and I want to buy an MRI machine and operate a private clinic. Ok, so I sink the whole $9.3 million into healthcare infrastructure. Canada's health system is $9.3 million stronger.

I don't see that Canada's healthcare system is any stronger. Kimmy's healthcare conglomerate is, but the healthcare systemis not improve by your mere possession of this machine without some further assumptions in this example.

In Sweal-World ...

Kimmy if you want to have a serious discussion it is necessary that you present your opponent's positions fairly and accurately. You have not done so in this case. I really don't have the patience necessary to mollycoddle people who should know better.

Breifly put, in "Sweal-world" you get to spend the after tax winnings on whatever you like because healthcare is ALREADY paid for from the taxes. Since combining everyone's tax money makes healthcare less expensive, you get to keep more money to buy your SUV.

... And yet we have laws to maintain a monopoly supply of this precious commodity...

Noooo. We have laws to maintain a monopoly on demand, not supply.

to whose benefit? 

The public benefit. The collective solution is less costly and more equitable. Conducted properly it would ensure more health is achieved overall.

So the logic I don't see is any support for a more expensive, inequitable, and therefor less publicly beneficial, private system.

[The Terrible Sweal]

Reading through this thread, I get the impression Sweal wants society to guarantee a "basic minimum" to all citizens and Sweal includes health care in the basic minimum.  IOW, Sweal wants a "guaranteed annual income". 

I do think that would be good, but I don't see it as directly conected to the healthcare question.

I suggest Sweal look at the "negative income tax" idea first.

I'm familiar withit somewhat through studying Milton Freidman. It sound like a good idea, but again, the connection to healthcare seems tenuous to me.

In the long run, no society can offer health services to all without imposing specific costs on some.

The significance of this point eludes me. No services of any kind can be offered without costs being paid (by someone).

eureka, you don't get it.  You think our health care system is in trouble because it lacks money (Mulroney, Martin, Harris never funded it properly).  eureka, you're wrong. 

What is your reason, then?

[Guest eureka]

I rather think, August, that you don't get it. The inquiries and Commissions that have studied and made recommendations about Canadian healthcare recently have all concluded that healthcare as a proportion of National Income has delined over the past decade or so except in Pharmaceuticals and certain types of equipment. This decline is entirely the consequence of cuts to funding.

These studies have also shown that wherever in the world there is private care, investment has leaked from the public sector. It is a given that when some can obtain better care simply because of their money, there will be money and resources taken from the public sector. Playing with figures and ideas will not alter that. One reason is that those who can pay also very much will control government policy and will no pay more through their taxes to support a system that they do not use.

I have posted several times now, that the ratio of public to private expenditure in Canada is about 70/30. Much the same as most European countries with none of those European countries spending less on public and some ranging close to 90/10.

It is not public vs private that is should be the issue but what should be public and what should be private.

I think that the Canadian system is by far the best in that it guarantees more or less equal treatment to all. We simply have to fix what we have deliberately broken and restore adquate funding.

Remember when Britain had the best system in the world by a very long way? It was a systen very much like ours but with even greater emphasis on the public sector. Thatcher broke that one for similar reasons to those that are now being expressed in Canada.

[August1991]

In the long run, no society can offer health services to all without imposing specific costs on some.

The significance of this point eludes me. No services of any kind can be offered without costs being paid (by someone).

The term "specific costs" is the main point.

At present, there is no direct connection between the amount people pay through taxes and the health services they consume. Users do not see a specific cost. This leads to innumerable problems and such a system is untenable in the long run. Margaret Thatcher described the problem best when she said that: "They have the usual socialist disease; they have run out of other people's money."

The inquiries and Commissions that have studied and made recommendations about Canadian healthcare recently have all concluded that healthcare as a proportion of National Income has delined over the past decade or so except in Pharmaceuticals and certain types of equipment. This decline is entirely the consequence of cuts to funding.

That is misleading, eureka. In 1975, health expenditure was 7.5% of GDP and in 2004, it was 10% (since 1993, it has varied around 9%-10%). You are right to note the current public/private split as 70/30.Stats available here

These statistics assume that money spent is equivalent to services rendered. That's not the case when the government spends the money. In addition, one of the ignored "costs" is the time patients and their families spend waiting in clinics and hospitals.

The Supreme Court's decision was based on waiting times. In the last federal election, health care was an issue because of waiting times.

eureka, you are right to say that throwing more money at the problem will solve it - temporarily. (Incidentally, PM PM's $40 billion health care deal will add almost 1% to the health care percentage of GDP.)

The fact of the matter is that since the 1960s, health care has taken an increasingly larger share of GDP and yet now we have queues.

[Sir Chauncy]

I find it amazing that Canadas "system" was inplaced years ago with very few taxes collected unlike today.

Highways were built and maintained without going in debt , yet today they cant even be kept in repair without huge debts being added to our already huge one.

Everything we have in Canada was done, put in place back then and no debt incured by it.

That all changed under Trudeau and yearly debts became normal and getting bigger by the year with less and less to show for that debt.

Too many are lining their pockets today and outright theft is blatent today. A billion dolaars simply lost a very few years ago. Remember that, money simply lost.

Accountability needs to be inplaced at every level of Governments in Canada, with real chages and punishment being meted out like it would be for any crook.

There is no reason our health system should be in the mess it is, nor the educational system.

Get rid of those pocket liners and perhaps the greedy unions and start getting back to realistic work ethics again.

Sir Chauncy

[Argus]

I rather think, August, that you don't get it. The inquiries and Commissions that have studied and made recommendations about Canadian healthcare recently have all concluded

When Eureka says "all" studies have concluded... that can be interpeted as "all studies I agree with" have interpreted. And these studies were by the likes of Roy Romanoff (gee, what a surprise that all he recommended was more money and more bureacrats!).

These studies have also shown that wherever in the world there is private care, investment has leaked from the public sector.

You know what? Nobody gives a crap except ideologues. The rest of us only care that you can walk into a hospital in Germany or France of Finland and get treated without waiting ten hours, get an MRI without waiting six months, get hip replacement surgery without waiting two years.

Remember when Britain had the best system in the world by a very long way?

No. I don't. And my memory goes back several centuries.

It was a systen very much like ours but with even greater emphasis on the public sector. Thatcher broke that one for similar reasons to those that are now being expressed in Canada.

Uhm, because it wasn't working? Because it was driving the state into bankruptcy? I bet you figure their coal industry was working just peachy too until the evil Thatcher destroyed it. British style socialism took the UK from one of the most powerful nations on earth to "the tired old man of Europe, with rusting, inefficient, state subsidised industries" and bloated, ineffectual government and government services.

[Argus]

I think you also need to reread. Take your time since, admittedly, the idea that the Right is wrong may be difficult for you.

<{POST_SNAPBACK}>

Ideologues like you just don't understand. This is not a right/left issue. I don't support private health care because of any kind of conservative agenda. I support it because the present system DOES NOT WORK and because the proponents of the system, like you, cling to it tenaciously, outright refusing any changes which will improve it and make it more efficeint. Wait times to see a doctor can climb to ten years and you'd still be shrieking in horror at the thought of introducing private health care. The rest of us are more realistic. We want whatever works. Since the present system does not work, and its supporters will not do anything to make it work, we've turned to something else. That's why 70% of Canadians approved of othe SC's decision and want to have access to more private health care. They know the bullshit system isn't working and can't be made to work because those who are in it have no interest in changes.

[The Terrible Sweal]

In the long run, no society can offer health services to all without imposing specific costs on some.

The significance of this point eludes me. No services of any kind can be offered without costs being paid (by someone).

The term "specific costs" is the main point.

At present, there is no direct connection between the amount people pay through taxes and the health services they consume. Users do not see a specific cost. This leads to innumerable problems and such a system is untenable in the long run. Margaret Thatcher described the problem best when she said that: "They have the usual socialist disease; they have run out of other people's money."

Well, at long last someone attempts something like an argument. If I understand correctly, you suggest that a public healthcare system will suffer from a 'tragedy of the commons' effect because there is no incentive to moderate one's consumption. Well, that could be a problem, I suppose, but, what is your reaction to each of these notions:

-accessing the healthcare system includes innate disincentives of inconvenience and exposure to sick people, and probes and tests and such;

-could market-type incentives be devised and applied to the user which maintain universality and would they solve the problem you identify;

-would reasonable rationing not solve the problem?

[Guest eureka]

It is , I agree, Argus, not a Left/Right issue so why the insistence on making it one. Everybody agrees that the system is not working as well as it should so why take an ideological position - one that has been shown to be wrong from experience everywhere - that only an injection of EXTRA private components can make it work?

The studies or commissions I refer to are not just Romanow's. His was by far the most exhaustive and it recommended a good deal more than more money. I refer also to Kirby and Mazankowski who both favoured the exclusion of private care. The two latter could not help bringing a "Right Wing" slant to their findings, but both wanted the continuation of the public system.

You talk of France but you seem not to have noted the recent reports that the French system is running into trouble and may need a rethinking of its private secor. It is one of the examples where there is now appearing cracks in the public sector because of the shifting of resources to the private.

This applies in every country. I have not followed the various studies but I have read and made a mental note of some of the conclusions. The most important is that there is not a single example in the developed world where a parallel system has not drained resources and money from the public sector.

That 70% of Canadians approve of the SCC's decision and want more access to private care has no significance. It simply shows that most people don't know what the decision was and that they have been conditioned with a decade of propaganda (from the Right, unfortunately) to believe that private care equals better care. That, in spite of all the evidence to the contrary. You can see it even in a forum like this where a few of the "Rightists" will accept nothing other than privatisation. They want this though a faith that equals the creatinism of the fundamentalists, not from any evidence that it would be other than a disastrous step.

[Guest eureka]

August, I have been preaching for years, the lost productivity from waiting in doctor's offices and clinics. I have never seen any estimates of what the figure might be. I suspect, though, that it is far more than the extra money the system needs to bring it to an efficient level.

The proportion of GDP has increased as I also noted without giving figures - I do not have them at hand. However, the increase is not in the system, as I also noted, but in the cost of pharmaceuticals and equipment that was not available at those earlier dates. It is also in the recent availability and treatments for things that were not previously covered.

The costs of personnel, hospital beds, and a myriad other things that make up the "system" has declined as a proportion of GDP. I have seen that reality in print many times. Obviously, I do not keep the references.

We need more doctors; more nurses; a more rational drug policy and, dare I say it, as I think Sweal suggested, some form of rational rationing.

[kimmy]

Yes, I'm aware that the the decision applies only to Quebec.  However, I'm sure that there will be challenges from elsewhere (I certainly hope Quebecers are not the only Canadians who have a guaranteed right to life and personal security!) 

Please don't play silly just for the mere sake of it. Of course others have such rights; what concerns us here is the meaning and extent of them.

I'm not playing silly. I'm quite serious. I assume that people in the rest of Canada have guarantees very similar to the ones ruled on in the Quebec case. And having ruled this way once, is there any reason to suspect the court won't rule the same way when similar laws are challenged elsewhere in Canada?

And having ruled this way once, has the SC not established a precident?

Precedent applies only to what the court actually and specifically decides, not to what it does not decide. So no binding precedent applies to the Canadian charter from this case.

"Binding precident" or not... surely the principles underlying the Quebec decision will apply in future decisions. Surely Supreme Court decisions are not random outcome events.

... is the aforementioned compelling argument against private healthcare now forthcoming?

It's already out there, and probably well enough known to you that I don't need to recite it here.

(...)

In thestructure of court case perhaps, but this is apulic policy debate. Anyway, private is less good than public because it is more expensive, not equitable and undermines the public effort.

yeah, but if the Supreme Court didn't buy that, why should I?

Tobacco, alcohol, and firearms are all demonstrably bad for society, but all of them are legal for sale with appropriate regulation. While we recognize the potential harm and apply appropriate regulation to reduce harm, we don't ban them outright because that wouldn't be consistent with our belief that adults should be able to engage in commerce if they wish.

Why can't we have a system that guarantees a standard of care for everyone but is also consistent with our belief in peoples' right to engage in commerce?

I have read these theads assiduously and I did not see any such explanation, though I hae seen many assertions to that effect.  Please EXPLAIN why private investment will yield better outcomes than equivalent public investment.

Profit motive will bring capital into the system to "bake a bigger pie™". That's not speculation; that's obvious. It's been noted by critics of the recent case that Dr Chaoulli's challenge was in part funded by other groups wanting to start private clinics. Quite obviously there's a lot of interest in putting private capital into healthcare.

Why will this yield better outcomes? Because shortage of capital is one of the major factors limiting the capacity of our healthcare system. We will be able to care for more patients.

I don't see that Canada's healthcare system is any stronger.  Kimmy's healthcare conglomerate is, but the healthcare systemis not improve by your mere possession of this machine without some further assumptions in this example.

Is Kimmy Imaging Inc performing MRIs in Canada? For Canadian patients? Ok, then I submit that I'm part of Canada's healthcare system.

... And yet we have laws to maintain a monopoly supply of this precious commodity...

Noooo. We have laws to maintain a monopoly on demand, not supply.

Ok, that needs some explanation.

As I see it, healthcare is the commodity in short supply, the high demand is evidenced by the long waiting lists, and laws like the one struck down in Quebec maintain a monopoly on the supply of healthcare services.

What does "a monopoly on demand" mean?

-k

[The Terrible Sweal]

I'm quite serious. I assume that people in the rest of Canada have guarantees very similar to the ones ruled on in the Quebec case. And having ruled this way once, is there any reason to suspect the court won't rule the same way when similar laws are challenged elsewhere in Canada?

I don't know the Quebec law well enough to know how like or unlike laws in the rest of Canada it may be. Certainly, it is possible that analogous facts will tend to have the same logic applied to them. However, there may be important differences in the laws which will produce different results.

Also, the composition of this judges on this bench will probably not be repeated when these other laws are tested, so the outcome is somewhat less than perfectly predictable. If you search the media you might find some interesting stories on this point.

...

In thestructure of court case perhaps, but this is apulic policy debate.  Anyway, private is less good than public because it is more expensive, not equitable and undermines the public effort. 

yeah, but if the Supreme Court didn't buy that, why should I?

The supremes didn't find against all of those reasons, they only found against the last one. (ANOTHER reason this decision is faulty, btw.)

As for undermining the public effort, you should be persuaded by my logic (and that of the dissenting judges).

Why can't we have a system that guarantees a standard of care for everyone but is also consistent with our belief in peoples' right to engage in commerce?

Well, I don't see any necessary conceptual problems with a regime of free market supply but the 'single payer' on the demand side. What would you say to that?

Let me know briefly and then I'll respond to the remainder of your (very interesting) comments.

[JerrySeinfeld]

How about we "boil it down" like this ... Which do you want?

(1) Everybody gets "5/10" healthcare regardless.

(2) Everybody gets "7/10", but can get "8/10" if they're willing and able to spend more."

Your Scenario Two is wildly speculative.

The real situattion is more like everybody gets 7/10 now, but people who can afford (in special situations) to pay for 9/10 want that privilege even though it means the base level for everyone will shrink to 4/10.

Actually TS, the supreme court disagrees with you and agrees with Kimmy. Read lines 61-65 of the ruling. It clearly states that despite government witness after witness, the government was unable to bring ANY credible evidence other than pure fear-mongering that a parallel private system would in ANY was harm the public system. So your theory is purely ideological and without empirical merit.

[Argus]

The real situattion is more like everybody gets 7/10 now, but people who can afford (in special situations) to pay for 9/10 want that privilege even though it means the base level for everyone will shrink to 4/10.

Why would the introduction of extra money into the system harm others?

To use one of my earlier examples. At present, all the clinics you can go to are privately operated. They don't work through the night, however, because of the difficulty in convincing doctors and nurses to work midnight shifts. If these private clinics could charge an extra fee for after hours service, say $10-$20, they could afford to pay a premium to employees, thus providing 24hr service.

This would allow people to get immediate attention if they were willing and able to pay. And it would ease the 7hr waits at emergency rooms during the night, so that poor people who couldn't pay the fee got faster service there.

Now how does this fee charging harm others and reduce services to them?

BTW, do you consider a 9-10hr wait at an ER to have a broken limb seen to as 7/10 service? Personally, I have a higher standard.

[The Terrible Sweal]

Actually TS, the supreme court disagrees with you and agrees with Kimmy.  Read lines 61-65 of the ruling.  It clearly states that despite government witness after witness, the government was unable to bring ANY credible evidence other than pure fear-mongering that a parallel private system would in ANY was harm the public system. 

So your theory is purely ideological and without empirical merit.

It seems you don't fully understand the situation. First, a Court decision is perfectly cpable of being either right or wrong ad this one is wrong. Next, the SCC passage you cite is not a majority conclusion on the overall issue. Nor is it an exhaustive analysis of public health policy. So much for the decision.

Now for the issue: you assert my "theory" is "ideological". Well then, you should be able to show how my position falls down on a logical basis, but so far that hasn't been accomplished.

[The Terrible Sweal]

Now how does this fee charging harm others and reduce services to them?

You've been told probably a hundred times. 1. Competion between public and private systems will cause prices to rise in the public system. 2. Balkanizing the system sacrifices cost savings from ecomomies of scale. 3. The requirement for profitablility will take that portion of money out of the system.

There is no logical policy reason that necessary resources cannot be provided publicly and funded through taxes. The only reason for going privately is that people don't want to pay what it takes to care for everyone -- i.e. short-sighted selfishness (the trademark of neoconservatism everywhere).